Mediation in a family-directed program for prevention of adolescent tobacco and alcohol use.

BACKGROUND: Family Matters is a universal intervention designed to prevent adolescent tobacco and alcohol use through involvement of family members and by targeting family risk factors for tobacco and alcohol use. Previously reported findings suggest that the program reduced the prevalence of both adolescent smoking and drinking in the 12 months after program completion. This paper reports analyses conducted to identify the mediators through which the program influenced adolescent smoking and drinking. METHODS: One thousand fourteen adolescents ages 12 to 14 years and their families, identified by random-digit dialing, were entered into a randomized trial. Adolescents and their parents provided data by telephone for measuring mediator and behavioral variables at baseline, 3 months, and 12 months after program completion. Repeated-measures logistic regression with generalized estimating equations was used to assess mediation processes. RESULTS: The program resulted in statistically significant changes in several substance-specific aspects of the family, such as rule setting about tobacco and alcohol use. However, the intermediate family effects did not account for the program effects on adolescent behavior. CONCLUSIONS: The variables hypothesized to explain program effects were not identified by direct empirical examination.

Correlates of participation in a family-directed tobacco and alcohol prevention program for adolescents.

This study examined correlates of program initiation and completion in a family-directed program that involved families of adolescents throughout the United States. Correlates varied by whether program initiation, program completion, or the number of activities completed was the indicator of participation. In final regression models, participation was relatively likely by non-Hispanic whites when compared with persons of race/ethnicity other than white, black, and Hispanic; by families with a female adolescent as the program recipient; by families with mothers who had many years of education; and by families with both parents living in the household. There was more participation if parents thought their child would smoke in the future and if the parent thought the adolescent did not smoke currently. Participation was higher if the adolescent felt strongly attached to the parent and if parents did not smoke. The findings are considered in the context of similar programs and future research on family-directed programs to prevent adolescent tobacco and alcohol use.

The influence of a family program on adolescent tobacco and alcohol use.

OBJECTIVES: This study examined a family-directed program's effectiveness in preventing adolescent tobacco and alcohol use in a general population. METHODS: Adolescents aged 12 to 14 years and their families were identified by random-digit dialing throughout the contiguous United States. After providing baseline data by telephone interviews, they were randomly allocated to receive or not receive a family-directed program featuring mailed booklets and telephone contacts by health educators. Follow-up telephone interviews were conducted 3 and 12 months after program completion. RESULTS: The findings suggested that smoking onset was reduced by 16.4% at 1 year, with a 25.0% reduction for non-Hispanic Whites but no statistically significant program effect for other races/ethnicities. There were no statistically significant program effects for smokeless tobacco or alcohol use onset. CONCLUSIONS: The family-directed program was associated with reduced smoking onset for non-Hispanic Whites, suggesting that it is worthy of further application, development, and evaluation.

Gender differences in the longitudinal predictors of adolescent dating violence.

BACKGROUND: Adolescent dating violence is a public health problem. The public health approach to prevention is to identify predictors of problem behaviors and develop interventions to eliminate or reduce those predictors with the intention of altering the chain of causation. Longitudinal data are preferred for identifying predictors of behavior but all dating violence studies have used cross-sectional data. We use longitudinal data to examine predictors of adolescent dating violence from several domains guided by an ecological perspective. METHODS: Eighty percent (N = 1,965) of the 8th- and 9th-graders in one county completed baseline questionnaires in school and 90% (N = 1,759) of those adolescents completed questionnaires again 1&1/2 years later. Proportional odds models were used to identify cross-sectional correlates and longitudinal predictors of dating violence perpetration that occurred between baseline and follow-up. RESULTS: Most of the study variables were correlated with dating violence in cross-sectional analyses. Having friends who are victims of dating violence, using alcohol, and being of a race other than white predicted dating violence perpetration by females. Holding attitudes that are accepting of dating violence predicted dating violence perpetration by males. CONCLUSION: The findings suggest that intervention strategies should vary for males and females and that when basing interventions on cross-sectional findings, scarce resources may be stretched to address persons who may not truly be at risk of beginning to perpetrate dating violence.

The Safe Dates program: 1-year follow-up results.

OBJECTIVES: An earlier report described desirable 1-month follow-up effects of the Safe Dates program on psychological, physical, and sexual dating violence. Mediators of the program-behavior relationship also were identified. The present report describes the 1-year follow-up effects of the Safe Dates program. METHODS: Fourteen schools were in the randomized experiment. Data were gathered by questionnaires in schools before program activities and 1 year after the program ended. RESULTS: The short-term behavioral effects had disappeared at 1 year, but effects on mediating variables such as dating violence norms, conflict management skills, and awareness of community services for dating violence were maintained. CONCLUSIONS: The findings are considered in the context of why program effects might have decayed and the possible role of boosters for effect maintenance.

Influence of a family-directed program on adolescent cigarette and alcohol cessation.

Programs to reduce adolescent cigarette or alcohol use by users in general populations have only recently been evaluated. Moreover, in spite of the substantial influence families have on their children, few family-directed programs designed to reduce the prevalence of adolescent smoking and drinking have been rigorously evaluated. This paper reports the findings of research designed to determine whether a family program reduced use of cigarettes or alcohol by users. The program consisted of a series of booklets mailed to families and follow-up telephone calls by health educators. A randomized experimental design involved families with children ages 12-14 throughout the United States. Data were collected by telephone at baseline and 3 and 12 months after the program was completed. No statistically significant program effects were observed for cessation or decrease in smoking and drinking by users.

The Authoritative Parenting Index: predicting health risk behaviors among children and adolescents.

Public health research demonstrates increasing interest in mobilizing parental influence to prevent health risk behaviors among children and adolescents. This research focuses on authoritative parenting, which previous studies suggest can prevent health risk behaviors among youth. To evaluate the reliability and validity of a new survey measure of authoritative parenting, data from studies of (1) substance use in a sample of 1,236 fourth- and sixth-grade students; (2) weapon carrying and interpersonal violence in a sample of 1,490 ninth- and tenth-grade students, and (3) anger, alienation, and conflict resolution in a sample of 224 seventh- and eighth-grade students were analyzed. The Authoritative Parenting Index had a factor structure consistent with a theoretical model of the construct; had acceptable reliability; showed grade, sex, and ethnic differences consistent with other studies; and identified parenting types that varied as hypothesized with multiple indicators of social competence and health risk behaviors among children and adolescents.

An evaluation of Safe Dates, an adolescent dating violence prevention program.

OBJECTIVES: This study assessed the effects of the Safe Dates program on the primary and secondary prevention of adolescent dating violence. METHODS: Fourteen schools were randomly allocated to treatment conditions. Eighty percent (n=1886) of the eighth and ninth graders in a rural county completed baseline questionnaires, and 1700 (90%) completed follow-up questionnaires. RESULTS: Treatment and control groups were comparable at baseline. In the full sample at follow-up, less psychological abuse, sexual violence, and violence perpetrated against the current dating partner were reported in treatment than in control schools. In a subsample of adolescents reporting no dating violence at baseline (a primary prevention subsample), there was less initiation of psychological abuse in treatment than in control schools. In a subsample of adolescents reporting dating violence at baseline (a secondary prevention subsample), there was less psychological abuse and sexual violence perpetration reported at follow-up in treatment than in control schools. Most program effects were explained by changes in dating violence norms, gender stereotyping, and awareness of services. CONCLUSIONS: The Safe Dates program shows promise for preventing dating violence among adolescents.

The Safe Dates Project: theoretical basis, evaluation design, and selected baseline findings.

Approximately 20% of adolescents have experienced violence from a dating partner. The Safe Dates Project tests the effects of a program on the primary and secondary prevention of dating violence among adolescents living in a rural North Carolina county. The program being evaluated aims to prevent dating violence by changing dating violence norms, gender stereotyping, conflict-management skills, help-seeking, and cognitive factors associated with help-seeking. School activities include a theater production, a 10-session curriculum, and a poster contest. Community activities include special services for adolescents in violent relationships and community service provider training. A pretest-posttest experimental design with random allocation of 14 schools to treatment condition was used to test study hypotheses. Data were collected in schools using self-administered questionnaires. Eighty-one percent (n = 1,967) of the eighth- and ninth-graders in the county completed baseline questionnaires, and 91% of those adolescents completed follow-up questionnaires. The sample is 75.9% Caucasian and 50.4% female. Baseline data indicate that 25.4% and 8.0% of this sample have been victims of nonsexual and sexual dating violence, respectively, and 14.0% and 2.0% have been perpetrators of nonsexual and sexual dating violence, respectively. Consistent with other adolescent dating violence studies, both boys and girls report being victims and perpetrators of dating violence. Control and treatment groups are similar at baseline on all demographic, mediating, and outcome variables. Findings suggest that dating violence is prevalent among adolescents and that prevention programs are warranted.

The interaction of sociological and biological factors in adolescent cigarette smoking.

This article considers the interaction of social and biological factors in the context of adolescent cigarette smoking. Parent and peer smoking are the sociological variables and testosterone is the biological indicator. The subjects are 212 males and females 12-14 years of age. The findings support the interaction model, suggesting that both sociological and biological factors are necessary for understanding adolescent smoking.

Effect of parental smoking classification on the association between parental and adolescent smoking.

Prior studies of the relationship between smoking by parents and their children have considered only current smoking by parents. In this study of 12- to 14-year-old adolescents, however, lifetime parental smoking was more strongly correlated with adolescent smoking than was current parental smoking. Indeed, lifetime parental smoking was as strongly correlated as peer smoking with adolescent smoking, and peer smoking is often considered to be the main determinant of adolescent smoking. These findings suggest that the relative role of parent smoking in adolescent smoking has been underestimated, and that new explanations for the association between parental and adolescent smoking are necessary.

Testosterone and cigarette smoking in early adolescence.

Social and psychological variables are used to explain why young people become cigarette smokers, whereas biological factors have been virtually ignored as possible determinants of that behavior. In this study, salivary testosterone was positively associated with cigarette smoking among 201 subjects 12-14 years of age. This finding suggests that testosterone should be included in future considerations of adolescent cigarette smoking.

Responses of patients to nutrition counseling by family physicians.

This paper examines patient responses to nutrition counseling activities of their family physicians. Two hundred-six patients (seen by one of nine family physicians) were asked whether the physician inquired about their dietary practices and whether they were asked to change any of these practices. Patients were also asked whether they understood, agreed with, and changed any of their dietary practices as a result of the consultation. Responses are examined in light of the self-reported physical condition of the patient. Patients without nutrition-related conditions were just as likely to be asked about their eating habits as patients with nutrition-related conditions. Patients with nutrition-related conditions were far more likely to report being asked to change their practices than patients with no nutrition-related conditions (p less than .001). However, self-reported change in dietary practices as a result of physician counseling did not vary by nutrition related condition.